| NPI | 1992891808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2014-0254) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G56515) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-03-07 |