| NPI | 1942689625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX T2910) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125066547) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: KY 53628) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2021-08-11 |