| NPI | 1699189787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: ND 16611) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S0837) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2020-09-14 |