| NPI | 1215419643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0097740) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.245384) |
| Enumeration Date | 2018-09-01 |
| Last Update Date | 2024-07-25 |