| NPI | 1528265360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R0391) |
| Additional Taxonomies | 208600000X Surgery (Licence: WY 8632A) |
| 208600000X Surgery (Licence: WI none) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2021-07-12 |