| NPI | 1730383654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 258114) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A113329) |
| 208600000X Surgery (Licence: WY TL2949) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2022-09-22 |