| NPI | 1043674328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD481399) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.027917) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-07-17 |