| NPI | 1558704130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.139898) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.139898) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2020-09-09 |