| NPI | 1023014487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 19048) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 236697) |
| 208600000X Surgery (Licence: RI MD11776) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: RI 11776) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2020-06-29 |