| NPI | 1063423895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: ND 10350) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 10350) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2018-06-08 |