| NPI | 1851349286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX E22577) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E-7153) |
| 208600000X Surgery (Licence: TX L6296) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2016-09-02 |