| NPI | 1831755602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A25109) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD H0103620) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2026-08-11 |