| NPI | 1275575953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09612100) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.088373) |
| 208600000X Surgery (Licence: TX M3214) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2024-04-29 |