| NPI | 1699771998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301035272) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 035272) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2016-02-23 |