| NPI | 1285783167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2006-00539) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.033301) |
| 208600000X Surgery (Licence: MI 4301028311) | |
| 208600000X Surgery (Licence: WY 6633A) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2012-10-03 |