| NPI | 1487768818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-02274) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX H4464) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2015-08-20 |