| NPI | 1205274131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301514863) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125-062909) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2025-10-02 |