| NPI | 1992806905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: WI 68587) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX Q5712) |
| 208600000X Surgery (Licence: MI 4301082195) | |
| 2086S0129X (Licence: TX Q5712) | |
| 2086S0129X (Licence: MI 4301082195) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2021-01-04 |