| NPI | 1689056186 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 010028) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R2477) |
| 208600000X Surgery (Licence: TX T3335) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2025-01-11 |