| NPI | 1538377833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME116513) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301086454) |
| 208600000X Surgery (Licence: NC 2011-01347) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NC 2011-01347) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2018-01-04 |