| NPI | 1336567601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101267342) |
| Additional Taxonomies | 208600000X Surgery (Licence: GU MD-P-2025-004) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: GU MD-P-2025-004) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-09-16 |