| NPI | 1457581308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA DO-05110) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH FU6195413) |
| 208600000X Surgery (Licence: IA FU6556584) | |
| 208600000X Surgery (Licence: NE FU6195413) | |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2024-04-18 |