| NPI | 1124513049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 57.249293) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2018017074) |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2023-03-17 |