| NPI | 1053677047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: FL ME169115) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: IL 036145468) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2024-08-29 |