| NPI | 1942414511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A111926) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57-007911) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-10-25 |