| NPI | 1023109683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C196248) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301073979) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-06-06 |