| NPI | 1649482910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 49793) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME113403) |
| 208600000X Surgery (Licence: CA A105216) | |
| 208600000X Surgery (Licence: MA 247573) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2024-04-01 |