| NPI | 1194720284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301104239) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35069105) |
| 2086S0127X Surgery, Trauma Surgery (Licence: MI 4301104239) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2022-07-21 |