| NPI | 1750333779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2017-00095) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35076372P) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-04-07 |