| NPI | 1124234356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301054641) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: MI 4301054641) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2018-10-22 |