| NPI | 1912981671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G65456) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: CA G65456) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2015-03-16 |