| NPI | 1073907077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 27381) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 67251) |
| 208600000X Surgery (Licence: ZZ 747066-07-M) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WV 27381) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MN 67251) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2024-07-10 |