| NPI | 1801312673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR1100X Clinic/Center, Research (Licence: VA 0101231722) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VA 0101231722) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OH 35.132187) | |
| 208600000X Surgery (Licence: VA 0101231722) | |
| 208600000X Surgery (Licence: OH 35.132187) | |
| 261QR1100X Clinic/Center, Research (Licence: OH 35.132187) | |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2021-10-05 |