| NPI | 1174987895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-56645) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: IA MD-56645) |
| 208600000X Surgery (Licence: OK 44500) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OK 44500) | |
| 208600000X Surgery (Licence: AR E-16333) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: AR E-16333) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CA A172696) | |
| 208600000X Surgery (Licence: CA A172696) | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2026-07-14 |