| NPI | 1053314195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2010005697) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35058426D) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2010-07-15 |