| NPI | 1891913604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MA 245666) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP00672) |
| 208600000X Surgery (Licence: MA 245666) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2018-08-09 |