| NPI | 1700063732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: TX V0384) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57013245) |
| 2086S0127X Surgery Trauma Surgery (Licence: OH 35130947) | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2024-06-10 |