| NPI | 1851375158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E4752) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM 2002-0497) |
| 208600000X Surgery (Licence: TX K7658) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-05-17 |