| NPI | 1063478022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35078332) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35078332) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2013-04-02 |