| NPI | 1235511015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX T4468) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX T4468) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2022-03-09 |