| NPI | 1053532564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD153994) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 5766654-1205) |
| 208600000X Surgery (Licence: CA A105995) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-02-16 |