| NPI | 1639128788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-06-3217) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35063217) |
| 174400000X Specialist (Licence: OH 35-06-3217) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2021-12-10 |