| NPI | 1083698435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2006-0035) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M1684) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2017-01-05 |