| NPI | 1730620170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: WV 3384) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP20079267) |
| Enumeration Date | 2017-03-18 |
| Last Update Date | 2024-05-28 |