| NPI | 1841239118 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208600000X Surgery (Licence: NV 15815) | 
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NV 15815) | 
| Enumeration Date | 2006-06-05 | 
| Last Update Date | 2025-03-19 |