| NPI | 1366420564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 41932) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 56304-020) |
| 208600000X Surgery (Licence: MN 41932) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-08-14 |