| NPI | 1295721751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 36598) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 9501173) |
| 208600000X Surgery (Licence: TX R5080) | |
| 208600000X Surgery (Licence: NM MD2019-0008) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2024-04-02 |