| NPI | 1558568733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 5101017324) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017324) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-02-12 |