| NPI | 1962401315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME164596) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L7953) |
| 208600000X Surgery (Licence: UT 6656178-1205) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2023-10-17 |