| NPI | 1659351617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.075650) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35075650W) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2021-10-28 |