| NPI | 1700085602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-34033) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN Temp 103081) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MN Temp 103081) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2010-11-30 |