| NPI | 1356336358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND 10920) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR R4107) |
| 208600000X Surgery (Licence: TX G9329) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2022-03-25 |