| NPI | 1245452606 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: ID M-17692) | 
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME98528) | 
| Enumeration Date | 2007-05-03 | 
| Last Update Date | 2024-03-27 |