| NPI | 1851698633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.122778) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 048527) |
| 208600000X Surgery (Licence: NY 61003921) | |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2024-02-29 |