| NPI | 1851920763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101289193) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101289193) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2026-07-24 |