| NPI | 1831621499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI MD20758) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 34701) |
| 208600000X Surgery (Licence: MA 1018883) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2025-06-13 |