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 |