| NPI | 1750329926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD51004) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD29450) |
| 208600000X Surgery (Licence: MO 2006010644) | |
| 208600000X Surgery (Licence: NC 2010-01273) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-03-30 |