| NPI | 1972882355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS 13080) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34010891) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2018-06-13 |