| NPI | 1306083456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A119540) |
| Additional Taxonomies | 207RB0002X Internal Medicine, Bariatric Medicine (Licence: CA A119540) |
| 2086S0127X Surgery, Trauma Surgery (Licence: MI 4301093223) | |
| 174400000X Specialist (Licence: TX R0307) | |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2023-07-07 |