| NPI | 1891131132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 51509) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 30083) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2019-04-17 |