| NPI | 1114127420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MA 290489) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD446869) |
| 208600000X Surgery (Licence: MA 290489) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: PA MD446869) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2022-01-03 |