| NPI | 1366761512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX U7802) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 25918) |
| 208600000X Surgery (Licence: TN 69804) | |
| 208600000X Surgery (Licence: AR E-9431) | |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2024-02-08 |