| NPI | 1508964917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AK MD3188) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: AK MD3188) |
| 2086S0102X Surgery Surgical Critical Care (Licence: AK MD3188) | |
| 2086S0127X Surgery Trauma Surgery (Licence: AK MD3188) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-11-12 |