| NPI | 1942299565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35094012) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 44265) |
| 208600000X Surgery (Licence: WV 22573) | |
| 208600000X Surgery (Licence: PA MD072108) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2020-12-17 |