| NPI | 1730333071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MI 4301102850) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301102850) |
| 2086S0129X (Licence: FL ME 124176) | |
| 2086S0129X (Licence: FL ME124176) | |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2023-11-06 |