| NPI | 1720460769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 63328) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301108141) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 63328) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2022-11-18 |