| NPI | 1699017509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MO 2019022428) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2019022428) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2022-03-01 |