| NPI | 1629500426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 89894) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS18748) |
| 2086S0102X Surgery Surgical Critical Care (Licence: SC 89894) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2023-10-06 |