| NPI | 1811970338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34-004295) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS003720L) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2013-06-11 |