| NPI | 1699767574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME38395) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 00008639) |
| 174400000X Specialist (Licence: FL ME0038395) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2018-05-04 |