| NPI | 1710915160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A88562) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD036096) |
| 208600000X Surgery (Licence: FL ME169728) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-09-03 |