| NPI | 1942250162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.070064) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35070064) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2018-01-22 |