| NPI | 1649477209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102203056) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34.0095-07) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2024-08-20 |