| NPI | 1801859525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME103058) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX K9166) |
| 208600000X Surgery (Licence: FL MFC1605) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2011-11-21 |