| NPI | 1952382905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C202975) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 35595) |
| 208600000X Surgery (Licence: MN 39676) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2025-10-13 |