| NPI | 1760002034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KS 94-12099) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR PG199459) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-07-28 |