| NPI | 1659336857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: AZ 58639) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD455975) |
| 2086S0102X Surgery Surgical Critical Care (Licence: PA MD455975) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2019-08-20 |