| NPI | 1730342817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CT 52468) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD434170) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2014-06-02 |