| NPI | 1518582345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 14279669-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34.017820) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2026-08-10 |