| NPI | 1730474115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 58734) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101258628) |
| 208600000X Surgery (Licence: OH 57.015725) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2022-07-25 |