| NPI | 1134531908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NV 19010) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 19010) |
| 208600000X Surgery (Licence: RI LP03107) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2021-08-31 |