| NPI | 1164606026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NC 2022-01915) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2022-01915) |
| 208600000X Surgery (Licence: LA MD.200997) | |
| 2086S0129X (Licence: TX N6165) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2025-06-17 |