| NPI | 1649590118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME147368) |
| Additional Taxonomies | 204F00000X Transplant Surgery (Licence: TN 62434) |
| 204F00000X Transplant Surgery (Licence: OH 127614) | |
| 208600000X Surgery (Licence: TN 62434) | |
| 208600000X Surgery (Licence: OH 127614) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2024-07-31 |