| NPI | 1689643637 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208600000X Surgery (Licence: TX R8186)  | 
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NV 19524)  | 
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX R8186)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101273072)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WY 10838A)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME152606)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CO CDRH.0055039)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TN MD0000064204)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: ID MC-0432)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: GA 73960)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MS 27572)  | |
| Enumeration Date | 2006-03-14 | 
| Last Update Date | 2025-05-29 |