| NPI | 1033166277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME121156) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 219190) |
| 208600000X Surgery (Licence: OH 90162) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2021-12-06 |