| NPI | 1578644373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101053710) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME-53184) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-12-20 |