| NPI | 1366404600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301094103) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61225865) |
| 208600000X Surgery (Licence: NY 226727-1) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301094103) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2022-02-23 |