| NPI | 1114556750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NE 37591) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 37591) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2026-09-08 |