| NPI | 1659733301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME163995) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101272379) |
| 208600000X Surgery (Licence: IL 125.069695) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-03-27 |