| NPI | 1730398165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 48134) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M-10274) |
| 208600000X Surgery (Licence: OH 35.126319) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2017-07-20 |