| NPI | 1023339371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 139429) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: CA 139429) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CA 139429) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2018-06-01 |