| NPI | 1700025251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD.38297) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101245994) |
| 208600000X Surgery (Licence: FL ME140684) | |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2024-01-18 |