| NPI | 1336102755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD52315) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D22254) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MD D22254) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2017-02-06 |