| NPI | 1780104778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0073993) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX U0840) |
| 208600000X Surgery (Licence: ND RL14687) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-01-16 |