| NPI | 1417417692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A197679) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN29577) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2024-07-15 |