| NPI | 1316196512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q0027) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: GA 003300) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2019-03-06 |