| NPI | 1750484630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-056700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.056700) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2017-05-03 |