| NPI | 1144211418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2024-023630) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35074468) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2025-01-22 |