| NPI | 1609262328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 288947) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 263564) |
| 208600000X Surgery (Licence: MO 2020016522) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2021-08-03 |