| NPI | 1518296847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD156908) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A107095) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2020-11-03 |