| NPI | 1659485142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: SC 23154) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 23154) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-08-16 |