| NPI | 1861424509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 079033) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2014-00014) |
| 208600000X Surgery (Licence: OH 35095068) | |
| 208600000X Surgery (Licence: VA 0101236790) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-03-01 |