| NPI | 1407290372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: LA 322143) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 26665) |
| 208600000X Surgery (Licence: LA 313121) | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2024-04-04 |