| NPI | 1861461113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35094319) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301078966) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2011-06-30 |