| NPI | 1306808860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101233378) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: PA MD438425) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2015-11-17 |