| NPI | 1578565461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME117113) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35048632B) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2020-10-28 |