| NPI | 1295752988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 57302-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35081883) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-11-15 |