| NPI | 1205147030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.129282) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 244152) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.129282) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036137737) | |
| Enumeration Date | 2010-06-26 |
| Last Update Date | 2021-07-28 |