| NPI | 1437389459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60232079) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N3711) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2019-05-28 |