| NPI | 1003092701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2012-0220) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N6734) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2020-03-16 |