| NPI | 1992948707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 57.016192) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 288644) |
| 208600000X Surgery (Licence: NC 2015-02325) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2020-06-15 |