| NPI | 1972730547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME180922) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2019009761) |
| 2086S0129X (Licence: MO 2019009761) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2026-07-01 |