| NPI | 1659466225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101221322) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD31721) |
| 208600000X Surgery (Licence: MD D0066199) | |
| 208600000X Surgery (Licence: TX J4324) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-12-03 |