| NPI | 1922259217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301109839) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.098493) |
| Enumeration Date | 2008-10-04 |
| Last Update Date | 2026-02-10 |