| NPI | 1356766554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS14617) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: FL OS14617) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2026-06-01 |