| NPI | 1477648160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME136693) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C10008237) |
| 2086S0129X (Licence: DE c10008237) | |
| 2086S0129X (Licence: NJ MA59847) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-11-13 |