| NPI | 1023503240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.154260) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301116113) |
| 208600000X Surgery (Licence: OH 35.154260) | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2026-01-21 |