| NPI | 1356633390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2016-00530) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME153579) |
| 208600000X Surgery (Licence: FL ME153579) | |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2021-11-24 |