| NPI | 1659774172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301105602) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301105602) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2014-10-02 |