| NPI | 1710052105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 37865) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME126137) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME126137) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2025-04-17 |