| NPI | 1033269170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: TX Q2559) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208600000X Surgery (Licence: TX Q2559) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX Q2559) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2023-08-15 |