| NPI | 1164435202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A114111) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N4039) |
| 208600000X Surgery (Licence: NY 238476) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX N4039) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-10-19 |