| NPI | 1891280061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-01612) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A154277) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2026-05-13 |