| NPI | 1770548463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 229035) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MA 229035) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2016-11-15 |