| NPI | 1699947697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0070835) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.006247) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2010-12-06 |