| NPI | 1174844815 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NV 27394)  | 
| Additional Taxonomies | 208600000X Surgery (Licence: CA A117835)  | 
| 2086S0102X Surgery, Surgical Critical Care (Licence: CA A117385)  | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD460329)  | |
| 2086S0127X Surgery, Trauma Surgery (Licence: CA A117385)  | |
| Enumeration Date | 2010-06-17 | 
| Last Update Date | 2025-06-26 |