| NPI | 1275511990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 80129) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 214748-1) |
| 208600000X Surgery (Licence: MA 80129) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2014-07-25 |