| NPI | 1922052828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00036873) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-067327) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2020-12-16 |