| NPI | 1477768364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD 60095073) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301081748) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OK 37785) | |
| 208600000X Surgery (Licence: WI 62490) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2024-09-18 |