| NPI | 1023200409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A111450) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301098091) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2020-02-25 |