| NPI | 1912941196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.094071) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 22388) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2011-04-18 |