| NPI | 1861658247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME122232) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101245118) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2020-09-10 |