| NPI | 1225011679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-07-7757-P) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2004-0360) |
| 208600000X Surgery (Licence: OK 23945) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2021-11-15 |