| NPI | 1356368948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: TX G0929) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX G0929) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2017-12-08 |