| NPI | 1659754232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MO 2022032501) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV DO2742) |
| 208600000X Surgery (Licence: NJ 00000) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2022-08-23 |