| NPI | 1740625573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2024-00842) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S3506) |
| 208600000X Surgery (Licence: VA 0101263403) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2024-10-01 |