| NPI | 1942499611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 57.013263) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.093930) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2024-07-22 |