| NPI | 1790705234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 7083) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MT 7083) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-12-03 |