| NPI | 1063618395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: CT 55142) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 55142) |
| Enumeration Date | 2007-06-24 |
| Last Update Date | 2017-01-13 |