| NPI | 1235457458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME121266) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME121266) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WI 72462-20) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2021-01-19 |