| NPI | 1487801957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-02477) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME120170) |
| 208600000X Surgery (Licence: ME MD26213) | |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2022-09-28 |