| NPI | 1245301084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G23030) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G23030) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-10-21 |