| NPI | 1174935217 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX V8108) | 
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036170087) | 
| 208600000X Surgery (Licence: WI 43923-20) | |
| 208600000X Surgery (Licence: TN 67923) | |
| 208600000X Surgery (Licence: TX V8108) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036170087) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WI 43923-20) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MO 2024010643) | |
| Enumeration Date | 2014-05-23 | 
| Last Update Date | 2025-08-14 |