| NPI | 1205064730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OK 33454) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125-056350) |
| 208600000X Surgery (Licence: TX Q1971) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2019-10-16 |