| NPI | 1952560195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34.010940) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017620) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2023-11-03 |