| NPI | 1508244955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD482310) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10053967) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-10-25 |