| NPI | 1821280223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI EMC0003750) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.092448) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2024-07-22 |