| NPI | 1649351941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G28898) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G28898) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-03-12 |