| NPI | 1134355399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301108768) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35. 092350) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2020-10-09 |