| NPI | 1972536969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OK 37979) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MO 2006018901) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2021-07-02 |