| NPI | 1366804593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301508312) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A172505) |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2022-12-21 |