| NPI | 1962853788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A172732) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN23842) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2023-09-28 |