| NPI | 1891112272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.141664) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2019-00627) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2022-01-25 |