| NPI | 1669488003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD041969) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 227496) |
| 208600000X Surgery (Licence: OH 35.095349) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-04-01 |