| NPI | 1255378303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G07508) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G079508) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2024-02-20 |