| NPI | 1982066056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036166283) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 316060) |
| 208600000X Surgery (Licence: OH 35.140929) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2024-02-06 |