| NPI | 1750497327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-054945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-054945) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2018-01-23 |