| NPI | 1598184731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61684844) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME128351) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2025-07-15 |