| NPI | 1205281623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: TX T4668) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 151587) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2023-12-18 |