| NPI | 1649683798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: ND 15900) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL13263) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2025-04-18 |