| NPI | 1861897423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS14459) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: FL OS14459) |
| 208600000X Surgery (Licence: GA 74123) | |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2022-08-03 |