| NPI | 1699055988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA A122915) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A122915) |
| 2086S0129X (Licence: AZ 52516) | |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2025-06-04 |