| NPI | 1609169994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: TX R8275) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R8275) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2023-03-24 |