| NPI | 1336306141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: OH 35.128427) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 241909) |
| 208600000X Surgery (Licence: NH 14547) | |
| 208600000X Surgery (Licence: DC MD037557) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2021-01-14 |