| NPI | 1518980671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA C52258) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0061299) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2019-01-19 |