| NPI | 1639139504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME171153) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200000101) |
| 2086S0129X (Licence: NC 200000101) | |
| 2086S0129X (Licence: VA 0101268071) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2025-02-18 |