| NPI | 1861650012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 83220) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD453463) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: SC 83220) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2022-01-04 |