| NPI | 1396745410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.058176) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-058176) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2019-09-27 |