| NPI | 1356668958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R8728) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.099723) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2023-09-08 |