| NPI | 1528124989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35091720) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD424357) |
| 208600000X Surgery (Licence: PA MD424357) | |
| 208600000X Surgery (Licence: OH 35091720) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2014-03-12 |