| NPI | 1275505026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 40212) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2018-01853) |
| 208600000X Surgery (Licence: VA 0101-040639) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101-040639) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: SC 40212) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2022-06-01 |