| NPI | 1316982606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX K2932) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME85122) |
| 208600000X Surgery (Licence: TX 47949) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2023-01-03 |