| NPI | 1740504885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: OH 34012658) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021641) |
| 2086S0129X (Licence: MI 5101021641) | |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2023-03-30 |