| NPI | 1114289667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MA 291400) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D89694) |
| 208600000X Surgery (Licence: MA 291400) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-04-20 |