| NPI | 1437573045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101020938) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 20A17209) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2022-12-14 |