| NPI | 1134307390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MN 49514) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 49514) |
| 208600000X Surgery (Licence: OH 35.093711) | |
| 208600000X Surgery (Licence: MN 49514) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.093711) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: OH 35.093711) | |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2011-09-14 |