| NPI | 1609122910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-00169) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NC 2021-00169) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2021-11-03 |