| NPI | 1427300029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: AZ 61358) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73479) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2023-07-14 |