| NPI | 1386094357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX S9855) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL39766) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX S9855) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-07-12 |