| NPI | 1124548508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101278248) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.030157) |
| 208600000X Surgery (Licence: MI 4351050200) | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-07-18 |