| NPI | 1730520362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 284984) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 260765) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2024-08-13 |