| NPI | 1922096817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35053968) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35053968) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2011-12-14 |