| NPI | 1245310200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MT MED-PHYS-LIC-124231) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA C52097) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-06-15 |