| NPI | 1245762251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD.49750) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX U4340) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: AL MD.49750) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2024-09-27 |