| NPI | 1528093218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35091608) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME96172) |
| 208600000X Surgery (Licence: ME 017404) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-06-15 |