| NPI | 1528074077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-12108) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: ID M-12108) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2023-10-03 |