| NPI | 1720251143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101249349) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101249349) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2022-12-05 |