| NPI | 1831194380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD068795L) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-07-7941-V) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2012-02-17 |