| NPI | 1013125046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60650940) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01063684A) |
| 208600000X Surgery (Licence: TX P5094) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2016-11-30 |