| NPI | 1558478909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME12887) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 13091) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2016-11-17 |