| NPI | 1033556543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: FL ME154139) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: VA 0101257728) |
| 208600000X Surgery (Licence: VA 0101257728) | |
| 2086S0127X Surgery Trauma Surgery (Licence: VA 0101257728) | |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2023-12-15 |