| NPI | 1659379832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: CT 52627) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 52627) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2019-04-24 |