| NPI | 1013185511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD452172) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC FC088719) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME111238) | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2019-07-25 |