| NPI | 1619311735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0085190) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10047144) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2018-08-22 |