| NPI | 1295220226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35147638) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10064964) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2023-07-19 |