| NPI | 1467421602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 10781) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 32458) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: SC 32458) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NV 10781) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2020-12-10 |