| NPI | 1265753263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35 129125) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01075165A) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2019-03-15 |