| NPI | 1275063745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MD D94224) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN24418) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-07-12 |