| NPI | 1366702722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 319454) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35139751) |
| Enumeration Date | 2012-05-20 |
| Last Update Date | 2022-10-07 |