| NPI | 1386091197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 1013562) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2016-05-22 |
| Last Update Date | 2024-09-12 |