| NPI | 1013950625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: TX J6096) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX J6096) |
| 2086S0102X Surgery Surgical Critical Care (Licence: GA 84928) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: OK 37473) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2022-04-29 |