| NPI | 1831358464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 30826) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 44153) |
| 208600000X Surgery (Licence: OH 35.127608) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2022-06-15 |