| NPI | 1518137223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI MD20757) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 16605) |
| 208600000X Surgery (Licence: CA C145443) | |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2025-06-16 |