| NPI | 1265747257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CA A133274) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301085632) |
| 208600000X Surgery (Licence: CA A133274) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2025-12-02 |