| NPI | 1588616148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 258054) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35064289) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35064289) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MA 258054) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: MA 258054) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2025-02-06 |