| NPI | 1841271731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 71635) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI MD17634) |
| 208600000X Surgery (Licence: ME MD24654) | |
| 208600000X Surgery (Licence: NH 21449) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2025-09-29 |