| NPI | 1942293097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OK 28445) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX H5534) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2017-11-10 |