| NPI | 1831142868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX E8821) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX Cert28481, licE8821) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2010-08-04 |