| NPI | 1780248021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME182642) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME182642) |
| 208600000X Surgery (Licence: TX V8739) | |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2026-07-21 |