| NPI | 1760456271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB04725200) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 93-00420) |
| 208600000X Surgery (Licence: OH 34-009971) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-02-05 |