| NPI | 1316022148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2023-0268) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M0746) |
| 208600000X Surgery (Licence: AL 00017674) | |
| 208600000X Surgery (Licence: WI 18392) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2025-02-03 |