| NPI | 1306838545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME 125954) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 27210) |
| 208600000X Surgery (Licence: OH 35-07-3218-G) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2021-02-18 |