| NPI | 1427037076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 21560) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 21560) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2016-08-10 |