| NPI | 1447269733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2018-00165) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L2215) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2018-02-21 |