| NPI | 1306891064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G77365) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G77365) |
| 2086S0102X Surgery Surgical Critical Care (Licence: CA G77365) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-07-08 |