| NPI | 1740415439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q9518) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2016-0954) |
| Enumeration Date | 2009-05-25 |
| Last Update Date | 2017-01-09 |