| NPI | 1295967966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 58458) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME128645) |
| 208600000X Surgery (Licence: TX N3061) | |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2022-01-04 |