| NPI | 1811966062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 11562) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NV 11562) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2020-04-10 |