| NPI | 1841401916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 287566-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101016220) |
| 208600000X Surgery (Licence: CA 20A11588) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2021-04-23 |