| NPI | 1588603732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301088944) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-093946) |
| 208600000X Surgery (Licence: TX M2206) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-08-27 |