| NPI | 1861765083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2024-03137) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34013505) |
| Enumeration Date | 2012-02-18 |
| Last Update Date | 2026-05-29 |