| NPI | 1801087093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA MD482247) |
| Additional Taxonomies | 2086S0129X (Licence: TX N9592) |
| 2086S0129X (Licence: WY TL3102) | |
| 208600000X Surgery (Licence: TX N9592) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2024-03-13 |