| NPI | 1154765477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI MD18832) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S1112) |
| 208600000X Surgery (Licence: OR MD214502) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2025-01-23 |