| NPI | 1184647315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 6446111-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34-00-8456) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-11-18 |