| NPI | 1124005806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ME MD23361) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 42169) |
| 208600000X Surgery (Licence: WI 56517) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: WI 56517) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: ME MD23361) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: ME MD23361) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2019-11-06 |