| 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 |