| NPI | 1326212994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A117189) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.014142) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2013-04-29 |