| NPI | 1205878279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2008004273) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35083353) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2026-06-23 |