| NPI | 1053376889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WY TL2018) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME69015) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2013-04-19 |