| NPI | 1720214935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35132197) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101248965) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OH 35132197) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2022-04-06 |