| NPI | 1689653172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N6002) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2004036076) |
| 208600000X Surgery (Licence: TX 42762) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2013-07-10 |