| NPI | 1720160971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 159523) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME141426) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME141426) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NY 159523) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2023-12-07 |