| NPI | 1508052408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-46845) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 246621) |
| 208600000X Surgery (Licence: OH 35-097903) | |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2021-08-17 |