| NPI | 1265639694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101017353) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MI 5101017353) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2019-06-28 |