| NPI | 1801916788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: AL DO.1350) |
| Additional Taxonomies | 2086S0129X (Licence: MS 20564) |
| 208600000X Surgery (Licence: GA 054665) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2025-11-18 |