| NPI | 1487867602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2009012110) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 58.001853) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-06-01 |