| NPI | 1710963871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101235503) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA C55042) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2020-05-06 |