| NPI | 1861481657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MA 55871) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 55871) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MA 55871) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2021-07-26 |