NPI | 1881840296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: OH 35.134273) |
Additional Taxonomies | 208600000X Surgery (Licence: NY 210440) |
Enumeration Date | 2008-08-18 |
Last Update Date | 2019-04-17 |