| NPI | 1306045570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101242239) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A78036) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2024-07-09 |