| NPI | 1346333655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX V5790) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G151411) |
| 208600000X Surgery (Licence: LA 15058R) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2025-01-29 |