| NPI | 1700079266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 50403) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 50403) |
| Enumeration Date | 2007-08-19 |
| Last Update Date | 2025-12-08 |