| NPI | 1831187483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35045146N) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35045146H) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2008-02-29 |