| NPI | 1376635193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: OH 35080770) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.080770) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-02-19 |