| NPI | 1417993247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA G88336) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G88336) |
| 2086S0129X (Licence: MA 70733) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2026-06-30 |