| NPI | 1801991492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX N5025) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N5025) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX N5025) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2016-01-21 |