| NPI | 1225233653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2016-01987) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MDR-5306) |
| 208600000X Surgery (Licence: OH 57.018107) | |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2016-11-30 |