| NPI | 1962288167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C195822) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: CA pending) |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2024-04-27 |