| NPI | 1679547137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NV 15380) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.089020) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2018-08-24 |