| NPI | 1578727996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD28531) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A89958) |
| 2086S0129X (Licence: OR MD28531) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2022-07-08 |