| NPI | 1407237092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: UT 11634089-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 262547) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2020-06-11 |