| NPI | 1679003875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA 072946) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: PA 006101) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-04-12 |