| NPI | 1780258749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX W6381) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX W6381) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2026-07-09 |