| NPI | 1861509325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: OH 35.150418) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301109248) |
| 2086S0129X (Licence: MI 4301109248) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2024-04-02 |