| NPI | 1871819417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A147798) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 56852-20) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2019-09-23 |