| NPI | 1639668569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX V1832) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: GA 111272) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2026-03-09 |