| NPI | 1245214303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35050388) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OH 35050388) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2022-11-03 |