| NPI | 1265694335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301097830) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD28996) |
| 208600000X Surgery (Licence: OH 91503) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2019-07-24 |