| NPI | 1891933305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35126280) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35126280) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2015-06-18 |