| NPI | 1528274503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301099055) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.011768) |
| 208600000X Surgery (Licence: MO 2009006855) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-01-23 |