| NPI | 1376753459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: ND 11197) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301081391) |
| 208600000X Surgery (Licence: ND 11197) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-03-29 |