| NPI | 1528167996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: ID OC-0063) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID OC-0063) |
| 2086S0102X Surgery Surgical Critical Care (Licence: CO CDRH.0060989) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: FL OS14155) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: GA 85476) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: MI 5101014249) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: MN 48973) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: WY 12672C) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-04-28 |