| NPI | 1871857821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101267151) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A132023) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2021-05-14 |