| NPI | 1790755700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: OH 35125021) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: OR 151261) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OR 151261) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2018-03-12 |