| NPI | 1972776862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35092131) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301082420) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2011-09-28 |