| NPI | 1144665845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: TN 61132) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 60114) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2022-03-15 |