| NPI | 1083750681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 46179) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: WV 23639) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2022-07-20 |