| NPI | 1942456322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CA A119713) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT190867) |
| Enumeration Date | 2008-08-17 |
| Last Update Date | 2025-07-01 |