| NPI | 1285888016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101255030) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57015676) |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2021-09-01 |