| NPI | 1588732804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-070727) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH OH35070727) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2010-05-13 |