| NPI | 1558578823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MI 4301088412) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301088412) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2015-12-31 |