| NPI | 1912353202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: AZ 69302) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT215464) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2023-07-17 |