| NPI | 1124181748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MI 4301056548) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: MI 4301056548) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-07-21 |