| NPI | 1861734626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301507427) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A154465) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2022-07-15 |