| NPI | 1679728604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q0537) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2013-00042) |
| 208600000X Surgery (Licence: OH 57.015102) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2022-11-21 |