| NPI | 1073740890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 65673) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MO 2012026114) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2026-06-08 |