| NPI | 1164594420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MI 5101008395) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NV CL0065) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-02-25 |