| NPI | 1275950388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.148529) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301509882) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2023-11-03 |