| NPI | 1114991668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: WA 49018) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 34199) |
| 2086S0102X Surgery Surgical Critical Care (Licence: TN 34199) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2011-08-18 |