| NPI | 1508201948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-01295) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S6315) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2023-10-24 |