| NPI | 1386628949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q8680) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 221129) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX Q8680) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2026-02-10 |