| NPI | 1619061942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME133602) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: LA MD.204457) |
| 208600000X Surgery (Licence: CO 42813) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-04-19 |