| NPI | 1497869812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NC 172903) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 22627) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2011-10-11 |