| NPI | 1609854405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: GA 86423) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX W1985) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TN 4564) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NV 1060) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL OS15153) | |
| 208600000X Surgery (Licence: VA 0102207306) | |
| 208600000X Surgery (Licence: NV 1060) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2026-09-18 |