| NPI | 1114007226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0116018906) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 20A18790) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2024-05-08 |