| NPI | 1073790622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: GA 060568) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 000566) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2020-09-09 |