| NPI | 1124438072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: AR E-17695) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX BP10050138) |
| 2086S0129X (Licence: TN 63127) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2025-02-24 |