| NPI | 1124432935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX S6715) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021141) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2022-12-20 |