| NPI | 1023498326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: NE 34913) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125066550) |
| 208600000X Surgery (Licence: PA MT222468) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2022-09-12 |