| NPI | 1124219381 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-18811) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MT 189539) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2025-01-16 |