| NPI | 1073510772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G45132) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35086364) |
| 208600000X Surgery (Licence: MO 2005019363) | |
| 208600000X Surgery (Licence: GA 071217) | |
| 208600000X Surgery (Licence: FL ME129329) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-12-30 |