| NPI | 1598767956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 26398) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD0000016842) |
| 2086S0129X (Licence: KY 26398) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2023-08-03 |