| NPI | 1750518304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 57.015155) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.124518) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2016-08-02 |