| NPI | 1962446559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102204179) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34.010110) |
| 208600000X Surgery (Licence: SC 37678) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-07-21 |