| NPI | 1497911804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CA A87704) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A8704) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2026-04-22 |