| NPI | 1700814118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 36495) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301072134) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2026-02-12 |