| NPI | 1750355046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD065330L) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.061950) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-12-27 |