| NPI | 1790206092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A203387) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD467935) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2025-07-24 |