| NPI | 1104205442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 12494828-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP100554443) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2023-03-03 |