| NPI | 1508841966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-02828) |
| Additional Taxonomies | 2086S0129X (Licence: MA 237957) |
| 2086S0129X (Licence: MI 4301073233) | |
| 2086S0129X (Licence: WA MD60594978) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2024-06-12 |