| NPI | 1063420701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 12548) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NV 12548) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2017-05-15 |