| NPI | 1316153604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 47614) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 67650) |
| 2086S0102X Surgery Surgical Critical Care (Licence: TN MD47614) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2019-02-18 |