| NPI | 1053597955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2009012459) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MO 2009012459) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2022-11-30 |