| NPI | 1780659276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A10859) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34010762) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2021-11-18 |