| NPI | 1801357827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NM MD2026-0641) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 25667) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2026-07-20 |