| NPI | 1366406639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2006-0484) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G5037) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2018-01-30 |