| NPI | 1215165162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM RS20090316) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NV 15405) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2015-06-09 |