| NPI | 1851581235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101284900) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101284900) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: UT 94513641205) | |
| 208600000X Surgery (Licence: NC 2010-01903) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2025-07-17 |