| NPI | 1073964615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WI 68239) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 68239) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2023-03-14 |