| NPI | 1134680978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: CA A207012) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A207012) |
| 208600000X Surgery (Licence: OH 35.153873) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2026-08-07 |