| NPI | 1063484210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101241616) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: OH 35.093895) |
| 208600000X Surgery (Licence: CT 61499) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: CT 61499) | |
| 2086S0102X Surgery Surgical Critical Care (Licence: VA 0101241616) | |
| 2086S0127X Surgery Trauma Surgery (Licence: VA 0101241616) | |
| 2086S0127X Surgery Trauma Surgery (Licence: OH 35.093895) | |
| 2086S0127X Surgery Trauma Surgery (Licence: CT 61499) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-06-21 |