| NPI | 1528088838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101240516) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.080184) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-09-18 |