| NPI | 1093163271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A175047) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10056910) |
| Enumeration Date | 2016-05-29 |
| Last Update Date | 2022-02-04 |