| NPI | 1598056483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: ND LT15520) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A123990) |
| 2086S0129X (Licence: CA A123990) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2019-01-23 |