| NPI | 1295826881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX T9485) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 19995) |
| 208600000X Surgery (Licence: NC 2015-00415) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-10-03 |