| NPI | 1487651550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 49770) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036085109) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036085109) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2018-06-18 |