| NPI | 1588911085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CA A129020) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 18141) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2020-11-05 |