| NPI | 1548600992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: OK 34961) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2013022036) |
| Enumeration Date | 2013-06-30 |
| Last Update Date | 2019-10-31 |