| NPI | 1528028719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: VA 0101232647) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101232647) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2016-04-01 |