| NPI | 1447257332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2006-01355) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 87276) |
| 208600000X Surgery (Licence: TN 76280) | |
| 208600000X Surgery (Licence: OH 35.151190) | |
| 208600000X Surgery (Licence: SC MD85045) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2026-04-17 |