| NPI | 1114147477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301081902) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35091326) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2024-01-18 |