| NPI | 1083670061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301050681) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35086755) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35086755) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: MI 4301050681) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: OH 35086755) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2017-10-20 |