| NPI | 1053628172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.120664) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301098147) |
| 208600000X Surgery (Licence: OH 57.012489) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.120664) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301098147) | |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2021-01-04 |