| NPI | 1275743502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P6818) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.131215) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OH 35.131215) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: OH 35.131215) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-12-13 |