| NPI | 1174618474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NM MD2016-0187) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 49118-020) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-11-17 |