| NPI | 1710307855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD473511) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A160862) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2021-10-13 |