| NPI | 1629157649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 250606) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-082089) |
| 208600000X Surgery (Licence: KY 39428) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-09-03 |