| NPI | 1548441058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-090208) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301091131) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2007-11-27 |