| NPI | 1003046525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: GA 076310) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 241-007) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2018-03-17 |