| NPI | 1578516704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35070212) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MS 21366) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2024-02-05 |