| NPI | 1427548767 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 77387) | 
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 77387) | 
| Enumeration Date | 2018-05-12 | 
| Last Update Date | 2025-07-08 |