| NPI | 1376624213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MS 18947) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: LA MD.025448) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-01-11 |