| NPI | 1861713729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C196917) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2014-02474) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2024-11-15 |