| NPI | 1437196482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD072993L) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME150438) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-07-21 |