| NPI | 1275982845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 95072) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R8937) |
| 208600000X Surgery (Licence: TX BP10057636) | |
| 208600000X Surgery (Licence: AL 45786) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2023-04-13 |