| NPI | 1306224811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301507296) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35141330) |
| Enumeration Date | 2015-05-16 |
| Last Update Date | 2022-06-02 |