| NPI | 1154648376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA OS014426) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS014426) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2016-08-10 |