| NPI | 1891933305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0056583) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: CO DR.0056583) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2025-08-14 |