| NPI | 1033437678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A128789) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN14639) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2021-12-21 |