| NPI | 1669592473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A 101690) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 98356) |
| 208600000X Surgery (Licence: NE 5358) | |
| 208600000X Surgery (Licence: NY 251627) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2023-05-31 |