| NPI | 1659457067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME113372) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL29087) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2013-02-01 |