| NPI | 1114188026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A116796) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35120572) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2021-12-01 |