| NPI | 1457570723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2007-00921) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NC 2007-00921) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2014-10-10 |