| NPI | 1467748210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101271422) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MI 4301500412) |
| 2086S0102X Surgery Surgical Critical Care (Licence: WI 61817) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2024-08-15 |