| NPI | 1275063745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 91916) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D94224) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: SC 91916) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-12-03 |