| NPI | 1558583534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 50539) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 45657) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-09-14 |