| NPI | 1053846469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 10964118-1205) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: ND 20983) |
| Enumeration Date | 2017-04-23 |
| Last Update Date | 2026-07-22 |