| NPI | 1073174108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4351045607) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.150576) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2025-08-01 |