| NPI | 1184986556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 51371) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 51371) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2018-11-08 |