| NPI | 1740436054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 46266) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: KY 46266) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2022-01-04 |