| NPI | 1619974797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2019007495) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34-008345) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2021-01-05 |