| NPI | 1205839404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2004012251) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MO 2004012251) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2024-04-25 |