| NPI | 1356795140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 58454) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35144073) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: KY TP815) | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2023-10-25 |