| NPI | 1326304924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD191751) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.127185) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2021-08-31 |