| NPI | 1275030140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 333167) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.147897) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-12-10 |