| NPI | 1508918319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35086758) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35086758) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2021-12-22 |