| NPI | 1689696809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101244376) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-070624) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2026-09-29 |