| NPI | 1982866109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34.011316) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017786) |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2015-11-19 |