| NPI | 1992763395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: WI 71047) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: FL ME87533) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-07-31 |