| NPI | 1770515751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 48124) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX K2127) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-10-22 |