| NPI | 1679539365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A11656) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR DO17797) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2012-11-28 |