| NPI | 1598966186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A107317) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN11197) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2012-10-15 |