| NPI | 1225532856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: OH 35.154581) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.154581) |
| 2086S0129X (Licence: VA 0101286079) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2026-01-15 |