| NPI | 1285980441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 61147-20) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NE 32110) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2025-11-03 |