| NPI | 1467032110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34.018433) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 58.031907) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2026-03-29 |