| NPI | 1063853539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA OS017951) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT015093) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2019-11-20 |