| NPI | 1710005087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2015-00853) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57-010147) |
| 208600000X Surgery (Licence: KY 43281) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2016-08-01 |