| NPI | 1750392361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2012-0835) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA C50247) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-09-15 |