| NPI | 1952626624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60877990) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A148159) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2022-10-20 |