| NPI | 1407269509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61256743) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.126489) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2022-06-16 |