| NPI | 1326487190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101285131) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT203620) |
| 208600000X Surgery (Licence: FL ME139862) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME139862) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2025-08-01 |