| NPI | 1881692697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD039604L) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-07-4596C) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2018-11-07 |