| NPI | 1306265616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.146396) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 88335) |
| 208600000X Surgery (Licence: WI 65232-20) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-08-17 |