| NPI | 1063673051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P8201) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP01484) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX P8201) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2025-02-12 |