| NPI | 1841645777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX S8585) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10055721) |
| 208600000X Surgery (Licence: NC 2021-00366) | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2022-08-17 |