| NPI | 1164802492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: OH 35.000000) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX BP10073728) |
| 208600000X Surgery (Licence: MI 4301107897) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2023-05-09 |