| NPI | 1073515862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 77713) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 023672) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2025-07-17 |