| NPI | 1578856647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: GA 98664) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 50136) |
| 208600000X Surgery (Licence: WV 29318) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: KY 50136) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WV 29318) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2024-04-11 |