| NPI | 1255451662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME110943) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 46356) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2012-01-19 |