| NPI | 1063594653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C186151) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML20008683) |
| 208600000X Surgery (Licence: ME MD19160) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2025-11-26 |