| NPI | 1356382345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 026953) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: GA 026953) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2015-03-26 |