| NPI | 1508974312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R0714) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX PROVISIONAL) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2017-11-13 |