| NPI | 1518454354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX V3289) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX V3289) |
| 208600000X Surgery (Licence: MA 1017854) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2025-09-11 |