| NPI | 1720081136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0051648) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35051892D) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2015-09-24 |