| NPI | 1689925844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA A142293) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 17291) |
| 208600000X Surgery (Licence: CA A142293) | |
| 2086S0129X (Licence: CO DR.0062897) | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2025-02-14 |