| NPI | 1821387549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 062701) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.121637) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2018-08-08 |