| NPI | 1255317038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 8793) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 219949) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: KS 04-29219) | |
| 208600000X Surgery (Licence: CO 49459) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2014-01-15 |