| NPI | 1427494624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VT 042.0014143) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A120275) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2018-09-05 |