| NPI | 1467423772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A66595) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A66595) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2024-02-08 |