| NPI | 1063856060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101267378) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.133380) |
| Enumeration Date | 2013-04-20 |
| Last Update Date | 2021-04-21 |