| NPI | 1962454900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VT 042-0017059) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 100403) |
| 208600000X Surgery (Licence: CO DR.0040580) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-07-27 |