| NPI | 1770836470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.131532) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301509587) |
| 208600000X Surgery (Licence: IL 125-059981) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2026-07-16 |