| NPI | 1932494655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-00319) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A161075) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2021-10-12 |