| NPI | 1124019963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NE 26640) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: NC 200100775) |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2014-04-23 |