| NPI | 1972704096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.126455) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 249748) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2018-03-13 |