| NPI | 1073520359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101057985) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-02368) |
| 208600000X Surgery (Licence: TX M1832) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2024-03-07 |