| NPI | 1740710433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 57.029336) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 1018489) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2024-07-16 |