| NPI | 1538484167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.099382) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0061483) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2018-11-05 |