| NPI | 1306376553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 73285) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 271797) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-09-10 |