| NPI | 1578588802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 12476) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35086597) |
| 208600000X Surgery (Licence: MO 2008011481) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2011-10-05 |