| NPI | 1801982467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 41239) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G58391) |
| 208600000X Surgery (Licence: NV 6635) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-09-11 |