| NPI | 1285891762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME130001) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME130001) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CO 19189) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX p6991) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2023-08-16 |