| NPI | 1295759520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA 00A768680) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: ID M-10954) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-06-30 |