| NPI | 1831206598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 19440) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NE 19440) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2011-07-01 |