| NPI | 1508811266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM 90-214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C51844) |
| 208600000X Surgery (Licence: CA C51844) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2016-02-10 |