| NPI | 1598394488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 8391568-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME171537) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME171537) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-07-10 |