| NPI | 1699113449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301502965) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.130421) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2024-05-28 |