| NPI | 1386848950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TX N0135) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX TEMP) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2016-12-19 |