| NPI | 1639669872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX V6976) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX V6976) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX V6976) | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2025-07-15 |