| NPI | 1730406067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA 188313 MT) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.142688) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2021-07-12 |