| NPI | 1609846708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101268993) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 85345) |
| 208600000X Surgery (Licence: NC 2006-00331) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101268993) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2022-08-26 |