| NPI | 1750671426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35-0413811) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301033212) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |