| NPI | 1427045285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35070121B) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 18596) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2019-07-30 |