| NPI | 1306838719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.065158) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2025-01256) |
| 2086S0129X (Licence: OH 35.065158) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2025-07-30 |