| NPI | 1548748908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2026-01458) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.146927) |
| Enumeration Date | 2018-07-29 |
| Last Update Date | 2026-06-05 |