| NPI | 1225045883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD050027L) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-04-8912) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2014-11-18 |