| NPI | 1285941765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.099447) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D73385) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2012-09-07 |