| NPI | 1902049422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0056137) |
| Additional Taxonomies | 208600000X Surgery (Licence: MT MED-PHYS-LIC-131296) |
| 208600000X Surgery (Licence: OH 35123183) | |
| 208600000X Surgery (Licence: CO TL.0003112) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2023-11-13 |