| NPI | 1700152592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 276937) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 276937) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2018-10-12 |