| NPI | 1952962912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 204915) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: CA 204915) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2026-06-16 |