NPI | 1912353202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 69302) |
Additional Taxonomies | 208600000X Surgery (Licence: PA MT215464) |
Enumeration Date | 2016-05-05 |
Last Update Date | 2023-07-17 |