| NPI | 1578139564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MI 5151015179) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151015179) |
| Enumeration Date | 2021-05-31 |
| Last Update Date | 2024-06-02 |