| NPI | 1104806256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME0068455) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME68455) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2013-05-06 |