| NPI | 1679960744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2024001046) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.136994) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2024-04-10 |