| NPI | 1356495634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C210538) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2009015690) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2026-08-26 |