| NPI | 1962644484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME150781) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 261886) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2023-04-19 |