| NPI | 1295028173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 54105) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME137769) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.131853) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2020-06-29 |