| NPI | 1003179342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.134156) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301101043) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-10-23 |