| NPI | 1245855295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: UT 14208464-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT221294) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2025-08-07 |