| NPI | 1265728638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10177100) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301099228) |
| 208600000X Surgery (Licence: OH 35129604) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2021-02-08 |