| NPI | 1699743591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101268865) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 81-4671690) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2020-04-22 |