| NPI | 1831585199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL OS17741) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS17741) |
| 208600000X Surgery (Licence: KY 04741) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL 6938) | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2023-02-24 |