| NPI | 1780606004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: TX R4219) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME111974) |
| 208600000X Surgery (Licence: NC 29106) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2022-08-09 |