| NPI | 1790999308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301515017) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME119060) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2025-10-10 |