| NPI | 1134460546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 3355) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 00000000000000000000) |
| Enumeration Date | 2013-03-09 |
| Last Update Date | 2018-08-02 |