| NPI | 1679591390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX N6169) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N6169) |
| 208600000X Surgery (Licence: MO 2009008955) | |
| 208600000X Surgery (Licence: SC LL29168) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-01-11 |