| NPI | 1982947875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD 17059) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA GFE 65476) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2013-03-29 |