| NPI | 1700296134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301105919) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301105919) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2026-08-25 |