| NPI | 1013120740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-46200) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A121357) |
| 208600000X Surgery (Licence: NE 25257) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: IA MD-46200) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: NE 25257) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: IA MD-46200) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2019-07-05 |