| NPI | 1568458701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.054539) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD16480) |
| 208600000X Surgery (Licence: ID M9619) | |
| 208600000X Surgery (Licence: WA MD00046059) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2024-09-16 |