| NPI | 1790848463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0062094) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD034910) |
| 208600000X Surgery (Licence: OH 35089496) | |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2022-01-08 |