| NPI | 1205860228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA MD492053) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.087566) |
| 2086S0129X (Licence: OH 35087566) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-09-23 |