| NPI | 1891991931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301104185) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 51789) |
| 208600000X Surgery (Licence: OH 35.089614) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35089614) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2023-09-15 |