| NPI | 1164793873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME129046) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP20039782) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2017-11-09 |