| NPI | 1154355790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2015-02091) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35099384) |
| 208600000X Surgery (Licence: TN MD34999) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-10-26 |