| NPI | 1982698627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD29718) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: TN MD29718) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2019-02-19 |