| NPI | 1245650746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 60875) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10050301) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2024-11-12 |