| NPI | 1093000119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.141868) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 39064) |
| 208600000X Surgery (Licence: MO 2011015600) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2021-05-28 |