| NPI | 1144541426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 10714776-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-244702) |
| 208600000X Surgery (Licence: OH 35.131751) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2023-10-10 |