| NPI | 1649478538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34.016155) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017294) |
| 208600000X Surgery (Licence: TN 2391) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2022-12-22 |