| NPI | 1619166535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204F00000X Transplant Surgery (Licence: FL ME100772) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME100772) |
| 208600000X Surgery (Licence: NC 2011-01105) | |
| 208600000X Surgery (Licence: SD 8180) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2025-11-22 |