| NPI | 1104853985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 26370) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MN 26370) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2007-07-09 |