| NPI | 1962537316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301105956) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME114095) |
| 2086S0102X Surgery Surgical Critical Care (Licence: MI 4301105956) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: FL ME114095) | |
| 2086S0127X Surgery Trauma Surgery (Licence: FL ME114095) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2019-10-29 |