| NPI | 1588041073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME157002) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 18497) |
| 208600000X Surgery (Licence: VT 042.0013787) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2022-08-12 |