| NPI | 1720062789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX G1419) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX G1419) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2021-11-23 |