| NPI | 1124087945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NC 2015-01969) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-01969) |
| 208600000X Surgery (Licence: PA MD033647E) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD033647E) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2019-06-05 |