| NPI | 1326041674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 50552) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35078185P) |
| 208600000X Surgery (Licence: KS 31818) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2024-05-03 |