| NPI | 1497042998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 1223) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2023-03446) |
| 208600000X Surgery (Licence: ME MD 21008) | |
| 208600000X Surgery (Licence: RI LP02286) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2024-02-09 |