| NPI | 1609088822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q0062) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT190363) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX Q0062) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-06-16 |