| NPI | 1659379998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME171359) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101231076) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2026-03-09 |