| NPI | 1053468140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.154799) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.154799) |
| 208600000X Surgery (Licence: ME MD21994) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: ME MD21994) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MO 2017021721) | |
| 208600000X Surgery (Licence: MO 2017021721) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2025-12-10 |