| NPI | 1972603934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX M4071) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M4071) |
| 202K00000X (Licence: TX M4071) | |
| 208600000X Surgery (Licence: CO 44107) | |
| 208600000X Surgery (Licence: NV 12654) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-11-28 |