| NPI | 1851382162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: OH 35130807) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036115529) |
| 208600000X Surgery (Licence: MO 2005030246) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2018-03-13 |