| NPI | 1083931067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MT MED-PHYS-LIC-113704) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M-14232) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2025-06-03 |