| NPI | 1558525055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301095801) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35 093635) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2021-04-01 |