| NPI | 1740501345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 50635) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NE 36924) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2025-07-23 |