| NPI | 1740508092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.137181) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD043278) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2022-01-25 |