| NPI | 1760876676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-17102) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA DR.0065272) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2023-10-27 |