| NPI | 1871821744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MT MED-PHYS-LIC-104207) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A164460) |
| Enumeration Date | 2009-12-03 |
| Last Update Date | 2022-03-30 |