| NPI | 1942598958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 93722) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2017011852) |
| 208600000X Surgery (Licence: TX S6569) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2023-02-20 |