| NPI | 1568646362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 84965) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0060658) |
| 208600000X Surgery (Licence: KS 04-31931) | |
| 208600000X Surgery (Licence: FL ME104200) | |
| 208600000X Surgery (Licence: TX N6580) | |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2020-07-08 |