| NPI | 1043273188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2007026645) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35086247) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2009-07-13 |