| NPI | 1487855276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35121813) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57012131) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2018-02-26 |