| NPI | 1760442040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 57865) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 57865) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2017-04-24 |