| NPI | 1457493751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI MD18401) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 064505) |
| 208600000X Surgery (Licence: ME MD27045) | |
| 208600000X Surgery (Licence: VT 0420011264) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2024-11-01 |