| NPI | 1477947653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME64473) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 008430) |
| 208600000X Surgery (Licence: OH 35.145497) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2024-01-09 |