| NPI | 1477593713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C192531) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 5181591-1205) |
| 208600000X Surgery (Licence: TX T3208) | |
| 208600000X Surgery (Licence: OR MD153200) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-03-13 |