| NPI | 1053643536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CA A149166) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10034421) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2020-05-01 |