| NPI | 1639312242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2025013256) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 13239) |
| 208600000X Surgery (Licence: OH 35.127225) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2025-05-22 |