| NPI | 1073938973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34-012867) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 0000000000000) |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2022-11-30 |