| NPI | 1114336260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A170738) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 7296) |
| 208600000X Surgery (Licence: TX S9046) | |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2025-05-20 |