| NPI | 1639331887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY TP286) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34.010446) |
| 208600000X Surgery (Licence: GA 70564) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2025-06-05 |