| NPI | 1073741195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301094772) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34014676) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 34014676) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2021-07-26 |