| NPI | 1538233572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA A71912) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI 10795) |
| 2086S0129X (Licence: HI 10795) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2023-06-29 |