| NPI | 1497168827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 287728) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MA 287728) |
| 2086S0102X Surgery Surgical Critical Care (Licence: PA OS019048) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2021-09-16 |