| NPI | 1629040845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ME MD19452) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 278096) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NY 278096) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX S5430) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD072744L) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME129110) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2020-12-21 |