| NPI | 1235332198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P9474) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2002005863) |
| 2086S0102X Surgery Surgical Critical Care (Licence: TX P9474) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2021-09-30 |