| NPI | 1558620328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 287517) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 20712) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2023-08-08 |