| NPI | 1093061905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MI 4301113482) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.062242) |
| 208600000X Surgery (Licence: MI 4301113482) | |
| Enumeration Date | 2012-07-29 |
| Last Update Date | 2021-10-04 |