| NPI | 1033347265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-01521) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL os13910) |
| 208600000X Surgery (Licence: MI 5101018249) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NC 2022-01521) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL os13910) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2025-05-14 |