| NPI | 1790987105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A108115) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2007025203) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2021-12-01 |