| NPI | 1780685792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: OH 35.088549) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD073786L) |
| 2086S0129X (Licence: SC 87498) | |
| 2086S0129X (Licence: WV 22508) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2024-11-04 |