| NPI | 1174598569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: LA 311445) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD056187L) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2019-02-11 |