| NPI | 1255312534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 53545) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: AZ 53545) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2019-07-05 |