| NPI | 1700225430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: IA DO-05374) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR PG163170) |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2024-03-05 |