| NPI | 1508127317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: VA 0101269455) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT201492) |
| 208600000X Surgery (Licence: VA 0101269455) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2024-03-21 |