| NPI | 1619056561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C156787) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM M2013-0263) |
| 208600000X Surgery (Licence: MA 229206) | |
| 208600000X Surgery (Licence: TX P1065) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2020-02-04 |