| NPI | 1700179660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35139875) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35139875) |
| 207P00000X Emergency Medicine (Licence: PA MD450447) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2022-08-08 |