| NPI | 1376737874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME163370) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2022007281) |
| 208600000X Surgery (Licence: GA 074569) | |
| 208600000X Surgery (Licence: CA A101986) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2023-08-10 |