| NPI | 1922094325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH OH35043893B) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 19816) |
| 208D00000X General Practice (Licence: OH 35-04-3893B) | |
| 207P00000X Emergency Medicine (Licence: OH 35043893) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2015-03-09 |