| NPI | 1831184175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: UT 175403-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 19071) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2015-01-12 |