| NPI | 1114441326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 36993) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 8074) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: IA MD-51731) | |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2025-08-04 |