| NPI | 1083638464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 023089) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: CT 023089) |
| 2086S0127X Surgery Trauma Surgery (Licence: CT 023089) | |
| 2086X0206X Surgery Surgical Oncology (Licence: CT 023089) | |
| 208C00000X Colon & Rectal Surgery (Licence: CT 023089) | |
| 2086S0105X Surgery Surgery of the Hand (Licence: CT 023089) | |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: CT 023089) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-02-01 |