| NPI | 1093153215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A164467) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301103294) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2020-06-02 |