| NPI | 1104145622 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL OS16261) | 
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS16261) | 
| Enumeration Date | 2010-05-24 | 
| Last Update Date | 2023-02-14 |