| NPI | 1548655228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301511890) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 145134) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2024-09-06 |