| NPI | 1891158457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: SC 88198) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 218355) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2023-09-15 |