| NPI | 1760696124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS012970) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT010133) |
| 208600000X Surgery (Licence: VA 0102203183) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: VA 0102203183) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: PA OS012970) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2024-03-12 |