| NPI | 1174776322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME113476) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 247238) |
| Enumeration Date | 2008-11-01 |
| Last Update Date | 2013-08-09 |