| NPI | 1598330896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 5151015049) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151015049) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2024-06-05 |