| NPI | 1588635437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD22704) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 13134) |
| 208600000X Surgery (Licence: MD D25182) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OR MD22704) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-07-08 |